Mobile applications
for informal caregivers: a systematic review of existing mobile applications
Kamila Skolik
s1416316
Master thesis Health Psychology & Technology
April 2018
Supervisors 1
stSupervisor dr. N. Köhle 2
ndSupervisor dr. C.H.C. Drossaert
University of Twente Drinerlolaan 5, 7522 NB Enschede The Netherlands
Faculty of Behavioural, Management and
Social Sciences
1
Abstract
Worldwide, there are many informal caregivers who care for someone without any financial reward. As a result, they may experience stress and negative feelings. They have to manage their own life together with the life of the person they care for. To support informal caregivers in these challenging situations, many different face-to-face and web-based interventions have been developed. However, these interventions have some disadvantages such as their limited accessibility, as they may be dependent on personal appointments or the availability of a computer. Furthermore, they might be time-consuming. Mobile health (mHealth) could be a possible solution to these problems. It can be integrated in the informal caregivers’ everyday lives, which means access to an intervention at any time. This study aims to examine which mobile applications for informal caregivers exist at the moment, what their content is, and what kind of mHealth features are incorporated in these mobile applications.
A systematic review in Apple’s App Store was conducted with the Dutch and English search terms “caregiver”, “mantelzorger”, “informal caregiver”, “mantelzoger”, and “informal care”. All mobile applications were analyzed in a systematic way with two extraction sheets.
One was about the content of the mobile applications related to caregiving tasks, such as information, facilities to improve contact to health professionals, practical tools, and related to informal caregivers’ well-being, namely peer support, psychological exercises, recreation and practical tools. The other extraction sheet was related to mHealth related features, namely multimodal presentation of content, interactivity, integrated in daily life, use of other hardware and use of related software. All mobile applications were rated with these extraction sheets by one rater.
The results showed that mobile applications for this target group are scarce (N=35).
Most of the content related features refer to practical tools related to caregiving tasks such as creating a care team (17%), and information on certain topics such as medical information (22%). Referring to mHealth related features, it appeared that the most used modal presentation is text-based (48%). Besides, the results showed that the mobile applications studied are relatively new (not older than six years old) and do not have any ratings in Apple’s App Store.
This study emphasized the limited availability of mobile applications for informal
caregivers; people, who could benefit from supportive tools not only about how to provide and
organize care but also how to increase their own well-being. Significantly, the existing mobile
applications were not fully making use of the potential of mHealth. Further research is needed
to examine which features are interesting and effective to incorporate in mobile applications for
informal caregivers.
2
Table of contents
Abstract ... 1
1.Introduction ... 3
Study aim ... 6
2.Methods ... 7
Search strategy ... 7
Data extraction ... 8
3.Results ... 11
Overview mobile applications ... 11
Content of mobile applications ... 13
mHealth related features ... 16
4.Discussion ... 18
Strengths and limitations ... 20
Further Research ... 21
Conclusion ... 21
5.References ... 22
3
1. Introduction
By 2050, 22 per cent of all people around the world will be 60 years of age or older, which is around one quarter of the world’s population (Wadd & Galvani, 2014). Worldwide, many people will be affected by this demographic change (O'connell, Chin, Cunningham, & Lawlor, 2003). As the number of elderly people with chronic diseases will increase, health-related costs will also increase. The responsibility for care is shifting from healthcare providers to patients and their families (Kajaks, Longfield, Orozco, Holyoke, & Dutta, 2015). Patients are staying at home instead of in hospitals. Family members and friends who provide care for someone with specific health problems, chronic diseases or other disabilities without any salary or financial compensation are called informal caregivers (Walker, Pratt, & Eddy, 1995; through Guay et al., 2017). In the Netherlands, almost 15% of the population, 18.1% of the nation’s women and 11.7% of its men (Sociaal en Cultureel Planbureau, 2015), are giving care to a family member or friend for an average of eleven hours each week (Centraal Bureau voor Statistiek, 2016).
According to Guay et al. (2017), informal caregivers do not only care for their loved ones, but also carry out different tasks. For example, they provide emotional support, take responsibilities for the household and children, and manage the care receivers’ diseases by scheduling appointments or administering medication (Stenberg, Ruland & Miaskowski, 2010).
There are some informal caregivers who may find the different tasks and responsibilities as a positive experience and associate being an informal caregiver with positive aspects, such as the special and intimate relationship with the patient that has developed due to the level of care given over a (long) period of time (Cohen, Colantonio, & Vernich, 2002). But there are also informal caregivers who experience all kind of burdens, which can have a negative influence on the their physical, emotional and social well-being leading to depression, anxiety, and high levels of stress (Zarit, Todd, & Zarit, 1986; through Guay et al., 2017; Adelman, Tmanova, Delgado, Dion, & Lachs, 2014). For example, partners of cancer patients often experience negative aspects such as feelings of sadness, fatigue or sleeping problems (Stenberg, Ruland,
& Miaskowski, 2010). Furthermore, they may experience difficulties with accepting the illness and dealing with it. Moreover, they may feel like they have a duty of care and must be there to support their loved one at all times (De Klerk, de Boer, Plaisier, Schyns, & Kooiker, 2015).
Some partners even forget to care for themselves including taking care of their own needs, wishes, and free time. This can lead to emotional and physical exhaustion and a so called
“emotional roller-coaster” with feelings of fear, guilt, helplessness and frustration (Stenberg,
Ruland & Miaskowski, 2010). Besides, informal caregivers who are taking care of someone
4 with physical disabilities or difficulties have higher risks of low back pain and back injury due to the physical care that they are providing (Kajaks et al., 2015).
Informal caregivers have various needs while caring for their loved ones which can be divided into being related to caregiving tasks and being related to the informal caregivers’ own well-being. Occasionally, informal caregivers might not know enough about how to give proper care or how to be empathetic to the patients’ needs in the way that is required. This is mainly due to the fact that they have not been given professional training on how to correctly care for a person with a certain chronic disease such as cancer or diabetes. Also, they might not know how to behave in their challenging situation (Sermeus, 2016). Therefore, informal caregivers need information on these topics (Docherty et al., 2008; Sobnath et al., 2017). Further, informal caregivers should be in contact with health professionals, such as general practitioners, oncologists, nurses or psychologists, to be up to date about the development of the disease and to receive (medical) support from a health professional who has a different perspective than the informal caregiver (Feeney et al., 2001). For the informal caregivers it these professionals should be easy to reach. Therefore, there is a need of facilities to improve the contact with these professionals. Occasionally, informal caregivers also experience some difficulties with the planning of tasks and general management of their loved one (caregiving related tasks) (Osse, Vernooij-Dassen, Schadé, & Grol, 2006). In this situation, they could make use of practical tools to help them with provide and organize care for the loved one such as creating a sufficient schedule including all important and caregiving related appointments (Osse et al., 2006;
Sermeus, 2016; Syrowatka, Krömker, Meguerditchian, & Tamblyn, 2016).
On the other hand, there are several needs regarding the informal caregivers’ own well- being separated from the act of giving care to the loved one. It is more about the informal caregivers themselves. They may experience the need to share their experience about personal feelings or to talk to people who are in the same situation to feel some support (Sermeus, 2016).
This can be done by being in contact with other informal caregivers, such as peer support. It is also possible to share information on social media or meet others in this way (Middelweerd et al., 2015). As already mentioned, some informal caregivers experience high levels of distress and difficulties coping with their emotions. In line with that, in studies, informal caregivers have indicated the need for information or exercises that can help them with these aspects.
Psychological exercises, such as mindfulness-based or relaxation exercises, may be helpful for them (Whitebird et al., 2012). Also, self-compassion, prayers or goal-setting can work as psychological exercises for informal caregivers to decrease stress levels (Neff, Hsieh, &
Dejitterat, 2005). Informal caregivers might also lack time for themselves and are often
5 consumed with feelings of responsibility and guilt when they do find some free time (Stenberg, Ruland & Miaskowski, 2010). This can be reduced by providing informal caregivers more personal recreation and free time, away from caring for their loved one (Cantor, 1983; Liu &
Yu, 2017). There are also practical tools related to themselves, such as recording own health records. To summarize, the following main categories play a crucial role for informal caregivers. First, related to caregiving tasks which are information, facilitaties to improve the contact with health professionals and related practical tools. Second, main categories related to informal caregivers’ own well-being which are peer support, psychological exercises, recreation, and related practical tools.
Several interventions have been developed to support informal caregivers in these domains, with the aim of supporting them in their daily life, reducing their burdens and maintaining their own health (Guay et al., 2017). There are many face-to-face interventions, but informal caregivers do not always have the time to meet with health professionals due to their caregiving tasks or other responsibilities. Also, some web-based interventions exist, such as “Hold on, for each other”, which support the partners of cancer patients (Köhle, Drossaert, Schreurs, Hagedoorn, Verdonck-de Leeuw, & Bohlmeijer, 2015) or the psychoeducational intervention
“Diapason” for informal caregivers of patients with Alzheimers (Cristancho-Lacroix, Wrobel, Cantegreil-Kallen, Dub, Rouquette, & Rigaud, 2015) . But some of the web-based interventions lack certain features, such as the availability of resources “on the go”, which means dependence on a computer for the informal caregivers.
A solution to this problem may lie in the possibilities mobile health (mHealth) could offer.
According to Roberts et al. (2016), informal caregivers’ preferences for communication is using a mobile application to text, such as a message from their children reminding them to take their medication or other treatment. They would also use mobile applications for monitoring and tracking purposes, such as medication intake (Roberts et al., 2016). mHealth is not only more affordable than face-to-face and web-based interventions, but also more accessible for informal caregivers (Chiarini, Ray, Akter, Masella, & Ganz, 2013). According to Silva, Rodrigues, De la Torre Díez, López-Coronado and Saleem (2015), mHealth can have major improvement on patients’ life. This is because of the possibility to connect to a smartphone anywhere anytime.
It is a “right-on-the-spot” opportunity. mHealth delivers healthcare services overcoming
geographical, temporal and even organizational barriers. Also, the size of a smartphone plays a
crucial role because it fits into hands and pockets, so informal caregivers can carry their
smartphones at all times (Miller, 2012). Mobile applications also include certain features that
other do not have. These features are the possibility to connect with other devices (Miller,
6 2012), GPS (Schoeppe et al., 2017), visual output and input of pictures or videos (Miller, 2012), audio output and input (Miller, 2012), haptic and motor features (Miller, 2012), sending awards and rewards (Schoeppe et al., 2017), push notifications (Schoeppe et al., 2017), reminder/alarm (Liu, & Yu, 2017; Schoeppe et al., 2017), uploading and downloading files (Liu & Yu, 2017), calendar (Liu & Yu, 2017), feedback (Syrowatka et al., 2016), making a personal account and offline usability. While dealing with mHealth, negative aspects have also been encountered, such as the use of private data and ethical issues (Gasser et al., 2006). The mHealth related features in this study are multimodal presentation, interactivity, integrated in daily life, use of other hardware, and use of software.
Although there are already existing mobile applications for informal caregivers that have been shown to be effective, such as PROTÉGÉ (Ferreira et al., 2013) and SafeBack (Kajaks et al., 2015), there has been no study about the exact features that can make the mobile applications more effective. Moreover, there is no study about the amount of available mobile applications for this target group including what kind of content the mobile applications have, and which mHealth features are used. That is why mobile applications for informal caregivers are interesting to investigate: they give new opportunities for global access of health services and medical care, especially for patients with chronic diseases and their informal caregivers (Chiarini et al., 2013).
Study aim
The aim of this study is to conduct a systematic review to find out three things: First of all, what
kind of mobile applications already exist for informal caregivers who care for someone with a
chronic disease? Second, what is the content of these mobile applications? Third, what are the
mHealth features of these mobile applications?
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2. Methods
A systematic review was conducted to get insights into the existing mobile applications for informal caregivers, their content and integrated mHealth features.
Search strategy
The search was conducted in Apple’s App Store on an iPhone 6 in the period from the beginning of October 2017 until the end of November 2017. The search was conducted using the following search terms: caregiver, mantelzorger, informal caregiver, mantelzoger, and informal care.
Certain inclusion and exclusion criteria were made. Only English and Dutch mobile applications that aimed to help and support informal caregivers who give care to someone with a chronic disease were included. Mobile applications about every other topic such as pregnancy, nannies, fitness or vaccines were not included in this study. Also, mobile applications dealing with finding (senior) care homes and caregivers, or those with technical problems or needing a special identification number or code to log in, were excluded. In addition, paid mobile applications, mobile applications only for patients, other languages than English and Dutch were excluded. Figure 1 shows a flow diagram of all included and excluded mobile applications.
Mobile applications were downloaded based on their description in Apple’s App Store and if
they fitted in the inclusion criteria or not. After downloading them, 45 mobile applications were
checked once more to see if they matched all inclusion criteria. From the total of 45 mobile
applications, 14 had to be excluded from the sample for different reasons (seven were not
related to the study topic, three had technical problems, two were only aimed at patients, one
was in another language, and one was an online magazine which had to be paid). After that, 31
mobile applications remained. The sample consisted of 35 mobile applications, 31 English and
four Dutch. Table 5 shows all included mobile applications with a short description, target
group and year of publishing.
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Figure 1. Flow diagram of included and excluded mobile applications of this study (N=35)
Data extraction
To review the mobile applications, two systematic data extraction sheets were developed. One was related to the content of the mobile applications related to the caregiving tasks including the main categories information, facilities to improve contact with professionals, practical tools, and related to informal caregivers’ own well-being including the main categories peer support, psychological exercises, recreation, and practical tools (see Table 1). The other sheet is related to the mHealth features with five main categories: multimodal presentation of content, interactivity, integrated in daily life, use of hardware, and use of software (see Table 2). Next to this, a short description, target group and year of publishing of the mobile applications were extracted. Based on the two extraction sheets it was decided if the content or mHealth features were included or integrated in the mobile application (present = 1, not present = 0). All mobile applications were rated by one rater.
Total found mobile applications Search terms: Caregiver (N=247), Mantelzorg (N=15), Caregiving (N=9), Mantelzorger (N=4),
Informal Caregiver (N=0), Informal Caregiving (N=0)
N=275
N=275
After check for in- and exclusion criteria - Different topic N=120 - Needed special login ID N=37
- Home care services N=21 - Technical problems N=20 - Caregiving finders N=15 - Paid mobile applications N=15
- Different language N=10 - Only for patients N=2
In total N=240 excluded mobile applications
Included mobile applications for this study
N=35
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Table 1. Content of Mobile Applications with Sub-categories and Definitions Main categories Sub-categories Short definitions
Related to the caregiving tasks
Information
Facilities to improve contact with professionals
Practical tools
Information about caregiving Medical information News
Contacts around List with professional contacts
Chat contact with professionals
Creating a plan/schedule Managing appointment Creating a care team Drug and disease search Saving prescriptions Making a to-do list Managing medication intake
List of emergency contacts Useful links other web-sites
Information about caring including communication between caregivers and patients, tips on caring, how to react in certain situations, and how to behave in a certain situation.
Information on medication and medical details.
Information about the latest news on caring and illness-related news.
Personal contacts of users linked to their own location (if so wished).
A list with professional contacts, such as health professionals, hospitals, pharmacies and 24/7 helplines is given.
Users can get in contact with professionals via text message.
A function to create a plan or schedule all important things related to caregiving.
A function to make and share appointments with others, such as family members or other informal caregivers.
A function which connects different people (informal caregivers) to create a care team.
Integrated dictionary to look up unknown words, which are related to drugs and disease.
A function which allows the user to save all prescriptions.
A function which helps the user to create a to-do list.
A function which helps the user to manage the medication intake of the patient.
A list with people and professionals to contact in an emergency.
An option to be led to other web-sides for additional (caregiving and disease related) information.
Related to informal caregivers’ own well-being Peer support
Psychological exercises
Recreation
Practical tools
Social support
Linking/sharing on social media
Mindfulness Relaxation Self-compassion Meditation Inspiring quotes Prayers Goal setting Events
Quiz and questionnaire Music
Calculators Own health records Symptom checker Stress test Tips
Maximizing personal energy
Getting in contact with others via a chat function and sending for example
“well wishes”.
Sharing files, such as photos or videos, on social media, e.g. Facebook.
Exercises based on mindfulness.
Relaxation exercises.
Exercises based on self-compassion, which consists of self-kindness, humanity, and mindfulness.
Meditation exercises.
Motivational and inspiring quotes to stimulate positive thinking.
If religious, prayers can be requested.
Users can set their own personal goals.
Caregiving events are listed.
Questions about knowledge of giving care and the informal caregiver’
feelings.
A function to listen to music.
Calculator function, which calculates the Body Mass Index, Body fat percentage.
An option to write down one’s own health records.
An option to check one’s own symptoms.
The user can conduct a short stress test.
A list with all kinds of tips for the informal caregiver.
Exercise to maximize energy.
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Table 2. mHealth features of Mobile Applications with Sub-categories and Definitions
Main categories Sub-categories Definitions
Multimodal presentation of content (system to user)
Information by video, text, audio Download information
Awards and rewards Making a personal account
Information given in video, text or audio form.
The possibility to download videos, photos or other files.
Awards or rewards for the user after completing something.
Creating a personal account including name, email, gender and password to be allowed to use the mobile application.
Interactivity User to system
- Uploading pictures, videos, other information
User to developer User to professional User to user
The mobile applications interact with the user.
The user can upload files such as pictures, videos or other information via a certain function.
The developer of the mobile applications interacts with the user.
Health Professionals can interact with the user.
Users can interact with each other.
Integrated in daily life
Push notifications Reminders/alarms Calendar Vibration Offline usability
A function to set up push notifications.
A function to set reminders and alarms.
Integrated calendar in the mobile application.
The option to turn the vibration on/off.
The mobile application can also be used offline.
Use of other hardware on mobile device
GPS
Connectivity with other devices
The mobile application can be connected to GPS.
The mobile application can be connected to other devices, such as a weight scale or Fitbit.
Use of related software
Data mining
Analysis of user patterns, such as voice or movement
The mobile application makes use of big data.
The mobile application can save user data, such as their voice, texts or movements.
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3. Results
In the following, the results of the systematic review will be presented. First, a general description of the existing mobile applications will be given. After that the results regarding the content of the mobile applications and their mHealth features will follow.
Overview of mobile applications
In total 35 mobile applications were found and used for further analysis. An overview of all mobile applications including their names, short description, target group and year of publishing is presented in Table 3.
Twenty-four out of 35 mobile applications were not specific for one group of patients with a certain chronic disease, such as cancer, but for more general use. This means that all informal caregivers can use these mobile applications no matter which chronic disease their loved ones have. Out of the other eleven mobile applications, six were aimed for informal caregivers of Alzheimer or dementia patients, two for informal caregivers of cancer patients, one for informal caregivers of stroke patients, one for informal caregivers of patients with autism, and one for adults with parents who have a chronic disease in general (see Table 3).
Further, all analyzed mobile applications are from no earlier than 2011 and do not have any ratings in Apple’s App Store. Five mobile applications are relatively new, as they were published last year (2017).
Table 3. Overview of Included Mobile Applications (N=35)
Applications’ names Description Target group Year of
publishing 1. genieMD Mobile application, which allows connection to other
devices and data, such as Apple HealthKit.
General 2013
2. Tender loving Elderly- Family Caregiver’s guide
Mobile application, which focuses on caregiving including “how-to’s”.
General 2016
3. Alzheimer’s Association Caregiver Buddy
Mobile application, which gives tips, support in areas of daily routine, communications, and behaviors.
For caregivers of dementia patients.
2015 4. American Caregiver
Association
Mobile application, which provides information for caregivers.
General 2015
5. Med Helper- Pill Reminder and Medication Tracker
Mobile application, which helps to keep all
appointments and medication information in one place.
General 2011
6. S3 Care-giver Wellness (Stroke-Support-Station)
Mobile application, which gives information, useful links, and enables the caregiver to keep track of their own (mental) health. It includes mindfulness exercises.
For caregivers of stroke patients.
2015
7. The Caregiver- PeaceHealth News
Mobile application, which gives an overview of information and news all about caregiving.
General 2015
8. Caregiver Community about Cancer
Mobile application, which helps to learn how to communicate about the fact of knowing someone who has cancer.
For caregivers of cancer patients.
2016
9. Caregiver Prayer Mobile application with daily encouragement. General 2016
10. OHCA caregiver (Oregon Health Care Association)
Mobile application, which gives access to the Oregon Caregiver, which is a magazine about caregiving.
General 2016
12
Table 3. Overview of Included Mobile Applications (Continued) 11. Alzheimer’s and Dementia
Tips for families (ALZ Videos)
Mobile application, which provides fast and easy access information by videos for caregivers.
For caregivers of dementia patients.
2015
12. My Cancer Circle (MCC) Mobile application, which is a community application, which helps coordinate help, such as transportation to medical appointments or giving support and information to caregivers.
For caregivers of cancer patients.
2013
13. Lotsa- helping hands This is a calendar mobile application, which helps to coordinate and communicate within family members and friends. It helps to organize stuff and provides the feeling of being connected. Is connected to My Cancer Circle.
General 2013
14. Birdhouse Mobile application, which helps parents to get organized with everything related to their children’s autism.
For parents of children with autism.
2013
15. DoseDirect Mobile application, which helps to organize the medication intake and works as a pill reminder.
General 2016
16. Caregivnig Events Mobile application, which provides family/care with information about caregiving events, such as conferences.
General 2017
17. 7th international carers conference (ICC 2017)
Mobile application about the international carers conference in October 2017.
General 2017
18. Carelocal- Alzheimer’s and Dementia Magazine
Mobile application, which is an online magazine with information all about Alzheimer’s and dementia.
For caregivers of patients with Dementia.
2016
19. GATSS Mobile application, which helps family members to stay connected with older family members who live alone. The iPhone or iPad works as an automated call for help. This is an alert application “when you can’t press the button”.
General 2014
20. CeyHello Medication Adherence & Patient
Mobile application, which is a personalized medication and management application. It supports all family members by giving a reminder to taking medicine.
General 2016
21. Caregivers Matter brought to you by GLSS
Mobile application, which is aimed to help caregivers by providing powerful tools anytime anywhere.
General 2017
22. SafeWander Mobile application, which sends an alert to caregivers’
mobile phone when the loved one gets up from bed or chair and leaves the room. It monitors the loved one from everywhere and includes a wearable sensor.
General 2015
23. Carely- Caregiving app for families
Mobile application, which wants to bring family members and caregivers together to reduce overall stress and create a good social network. Their motto is: care + family = carely
General 2013
24. Flower: Support Registry to help family & friends
With this mobile application, the user can easily ask for help. It is a “we take care of each other” application.
General 2016
25. eCare Vault Mobile application, which helps to create virtual care teams for loved ones.
General 2017
26. eCare App Mobile application, which helps to enroll every family/
care member into the application, so they are connected.
General 2016
27. Old Smarts Mobile application, which is aimed to help the elderly, their family members and caregivers to find everything that can help the elderly in daily life.
General 2016
28. CareZapp Mobile application, which supports the user in caregiving, helping him/her to share the care and bring peace of mind.
General 2015
29. CareZone Health organizer Mobile application, which helps to manage caring of a loved one.
General 2017
30. Caregiving Quiz Mobile application about a quick quiz including several questions on the topic of caregiving.
General 2012
31. Caregiving groups Mobile application, which helps to create caregiving groups.
General 2016
32. Fello Mobile application, which helps to create caregiving groups and manage/divide tasks related to it, including a calendar.
General (Dutch) 2015
33. Alzheimer Assistent Mobile application with all kinds of information about Alzheimer’s. It helps to connect with others and gives links to other useful sites.
For caregivers of patients with Dementia (Dutch)
2013
34. Zorgsamen Mobile application, which helps to create tasks and divide them with others; including a logbook.
General (Dutch) 2016 35. Empowerment Mobile application, which helps young adults (10-20
years) to learn how to deal with a parent who has a chronic disease. This mobile application includes information and a test.
For caregivers who have a parent with chronic disease (Dutch)
2016
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Content of mobile applications
Eighteen out of 35 mobile applications, used integrated information related to caregiving tasks, which means how to give care, what to do in emergency situation, what to say to the loved one or in general what it means to be an informal caregiver (see Table 4).
Table 4. Overview of Content offered in the analyzed Mobile Applications (N=35)
Main categories N=35 % Sub-categories N %
Related to caregiving tasks Information
Facilities to improve contact with professionals
Practical tools
18
9
29 51
26
83
Information about caregiving [3;4;5;7;8;11;12;18;21;24;27;33;35]
Medical information [1;11;12;20;21;33]
News [1;7;10;18;27]
Psycho-education [11;27;33]
List with professional contacts [1;3;5;20;29;33]
Contacts around [1;17;31]
Chat contact with professionals [4;17;20]
Useful links to other websites
[1;3;4;6;9;10;11;12;17;18;21;24;26;27;32;33;35]
Creating a planning/schedule
[1;5;12;13;14;15;17;20;22;23;24;26;31;32]
Creating a care team [1;12;13;19;22;23;24;25;28;31;32]
Managing appointments [5;12;13;14;15;22;23;32]
Drug and disease search [1;8;24;27]
Managing medication intake [5;15;20;29]
Making a to-do list [8;29;34]
List of emergency contacts [1;5]
Saving prescriptions [5]
N=27 13 6 5 3 N=12 6 3 3 N=64 17 14 11 8 4 4 3 2 1
48 22 19 11
50 25 3
27 22 17 13 6 6 5 3 2 Related to informal
caregivers’ own well-being Peer support
Psychological exercises
Recreation
Practical tools
10
6
11
10 29
17
31
29
Social support [12;13;14;17;20;24;33;34]
Linking/sharing social media [4;10;14]
Inspiring quotes [1;9;26]
Mindfulness [6]
Meditation [8]
Requesting prayers [9]
Relaxation [21]
Events [7;16;17;24;31]
Quiz and questionnaire [6;12;28;30;35]
Music [21]
Tips [3;8;21;26]
Own health records [1;20;29]
Calculators [1;20]
Symptom checker [20;29]
Stress test [27;35]
Maximizing personal energy [2]
N=11 8 3 N=7 3 1 1 1 1 N=11 5 5 1
N=14 4 3 2 2 2 1
73 27
43 14 14 14 14
45 45 10
29 21 14 14 14 7
14 Further, information on how to care for someone with a chronic disease was given in thirteen mobile applications (see Figure 2). Also, medical information, such as side effects and information about the disease itself was given in five out of all mobile applications.
Figure 2. My Cancer Circle (Information)
In addition, nine out of 35 mobile applications used features to facilitate contact with different health professionals, such as psychologists, general practitioners or nurses. This was done by providing a list with professional contacts including addresses or telephone numbers to make it more visible for the informal caregiver. Three out of all mobile applications offered to find professional contacts in the vicinity, located by a GPS function. So, the informal caregivers can access professional help and support not far away. Almost all mobile applications, 29 out of 35, used features as a practical tool related to caregiving. The practical tool used the most is providing links to other web-sites. This was done in 17 mobile applications. Fourteen mobile applications included a function to create a plan or schedule for the informal caregiver and their loved one, eleven for creating a care team with their family members or close friends (see Figure 3), and eight for managing appointments (see Figure 4).
Further, four mobile applications included a function to search for drug and disease information
and managing the medication intake of the loved one. Only ten out of 35 mobile applications
integrated tools for the informal caregiver themselves. Four out of the ten mobile applications,
integrated several tips especially for informal caregivers (see Figure 5). Further, informal
caregivers could write down their own health records, check their own symptoms (if applicable)
or fill in a stress test.
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Figure 3. Carely (Creating Care Team) Figure 4. Lotsa (Calendar) Figure 5. Caregiver Buddy (Tips)
Some mobile applications integrated features related to informal caregivers’ own well-being.
Ten out of 35 mobile applications used functions to stimulate peer support to get in touch with others. This is usually done by giving users the opportunity to contact other users via the mobile application. Further, it was possible to be linked to others or just sharing personal information, such as files, pictures or videos (on social media such as Facebook) so other users can read and see each other’s stories and start to get in contact with each other. Moreover, there is also an option to send “well -wishes” to each other with the hope and support that the loved one will make it through, and just as a support for each other. Remarkably, psychological exercises to increase well-being of the informal caregivers are only offered in six out of 35 mobile applications. Three mobile applications used inspiring and motivational quotes to stimulate positive thinking. Further, only one mobile application integrated a mindfulness exercise, one mobile application a meditation exercise and one mobile application a relaxation exercise.
There was also one mobile application giving the user the opportunity to request a prayer from
someone else within the application. Self-compassion and goal-setting exercises have not been
integrated in the mobile applications at all. The next category, which is integrated in eleven out
of the 35 mobile applications, is the recreation and free time of the user. Five out of the eleven
mobile applications integrated some information about events and conferences that informal
caregivers might visit in their free time. Further, there is one mobile applications with some
music function, so the informal caregiver may listen to music if so wished.
16
mHealth related features
All analyzed mobile applications included some features from the multimodal presentation category. Twenty-eight out of 35 mobile applications included text-based information. Only seven out of 35 mobile application offered information via videos and two via audio files.
Twenty-two out of 35 mobile applications integrated the function to create a personal account before starting to use the mobile application. This option included personal details of the informal caregivers, such as name, email address, age, gender, and sometimes also if other informal caregivers are involved.
Table 5. Results of mHealth Features
Main categories N % Sub-categories N %
Multimodal presentation (user to system)
35 100
Information by:
- Text
[2;3;7;8;10;12;13;14;15;16;17;18;19;20;22;23;24;25;26;27;
28;29;30;31;32;33;34;35]
- Video [1;4;6;11;21]
- Audio [5;9]
Making a personal account to make use of the mobile application [1;5;12;13;14;16;17;19;20;21;22;23;24;25;26;27;28;31;32;33;34;35]
Download information Awards and rewards
N=58
28 5 2 22 1 0
48 9 3 37 2 0
Interactivity 35 100
User to system [5;6;8;9;15;16;17;21;22;25;26;27;30;31;34;35]
Uploading:
- Pictures [8;12;17;23;25;29]
- Videos [25;29]
- Information [8;12;29]
User to developer [1;2;7;11;14;18;28;29;33]
User to user [1;12;13;19;20;23;24;28;32]
User to professional [1;3;4;10;33]
N=50 16 6 2 3 9 9 5
32 12 4 6 18 18 10 Integrated in daily life 28 80
Offline usability [5;6;7;8;9;11;15;16;17;18;21;24;26;27;29;30;33;35]
Calendar [5;12;13;14;15;22;23;29;31;32]
Reminders/alarms [1;8;14;15;19;26;28]
Push notifications Vibration
N=35 18 10 7 0 0
51 29 20 0 0 Use of other hardware
on smartphone
5 14
GPS [1;17;31]
Connectivity and connections with other devices [1;20;22]
N=6 3 3
50 50 Use of related
software
1 3 Analysis of user patterns, such as voice or movement [22] N=1 100
Also, all analyzed mobile applications included features with interaction. In total, 16 out of 35
mobile applications had an interaction between the user and the mobile application. That means
that the user was interacting and receiving feedback from the mobile application itself. Nine
mobile applications integrated an interaction between the user and the developer of the mobile
application, and nine mobile applications integrated an interaction between all users. Only five
17 mobile applications included an interaction or the opportunity for interaction between the user of the mobile application and a health professional, such as a nurse or psychologist.
Twenty-nine out of 35 mobile applications used features which are integrated in daily life. The most integrated feature was offline usability, which means that the user may use the mobile application any time without needing to be connected to the internet. Further, ten mobile applications included a calendar function for all caregiving related appointments. Seven mobile applications had the function of setting reminders or alarms. There was no function to regulate the use of vibration.
Five out of 35 mobile applications made use of integrated hardware on the smartphone.
Three mobile applications used a GPS function, which may help the user to find health professionals and other users in their vicinity. Three mobile applications made use of the possibility to connect with other devices or mobile applications, such as the Fitbit or Apple HealthKit (see Figure 6 and Figure 7). Only one of all the mobile applications made use of related software, which is a mobile application that counts and analyzes the foot-steps the user makes. No mobile applications make use of data mining such as big data.
Figure 6. CeyHello Figure 7. GenieMD
